Provider Demographics
NPI:1427388743
Name:RODRIGUEZ, NOELLE C (MA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 PEARL ST APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2653
Mailing Address - Country:US
Mailing Address - Phone:310-450-2990
Mailing Address - Fax:310-450-2990
Practice Address - Street 1:1421 PEARL ST APT D
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2653
Practice Address - Country:US
Practice Address - Phone:310-450-2990
Practice Address - Fax:310-450-2990
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB35103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional